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Friday, October 28, 2022

Gender and ethnicity bias in medicine: a text analysis of 1.8 million critical care records

David M Markowitz
PNAS Nexus, Volume 1, Issue 4,
September 2022, pg157


Gender and ethnicity biases are pervasive across many societal domains including politics, employment, and medicine. Such biases will facilitate inequalities until they are revealed and mitigated at scale. To this end, over 1.8 million caregiver notes (502 million words) from a large US hospital were evaluated with natural language processing techniques in search of gender and ethnicity bias indicators. Consistent with nonlinguistic evidence of bias in medicine, physicians focused more on the emotions of women compared to men and focused more on the scientific and bodily diagnoses of men compared to women. Content patterns were relatively consistent across genders. Physicians also attended to fewer emotions for Black/African and Asian patients compared to White patients, and physicians demonstrated the greatest need to work through diagnoses for Black/African women compared to other patients. Content disparities were clearer across ethnicities, as physicians focused less on the pain of Black/African and Asian patients compared to White patients in their critical care notes. This research provides evidence of gender and ethnicity biases in medicine as communicated by physicians in the field and requires the critical examination of institutions that perpetuate bias in social systems.

Significance Statement

Bias manifests in many social systems, including education, policing, and politics. Gender and ethnicity biases are also common in medicine, though empirical investigations are often limited to small-scale, qualitative work that fails to leverage data from actual patient–physician records. The current research evaluated over 1.8 million caregiver notes and observed patterns of gender and ethnicity bias in language. In these notes, physicians focused more on the emotions of women compared to men, and physicians focused less on the emotions of Black/African patients compared to White patients. These patterns are consistent with other work investigating bias in medicine, though this study is among the first to document such disparities at the language level and at a massive scale.

From the Discussion Section

This evidence is important because it establishes a link between communication patterns and bias that is often unobserved or underexamined in medicine. Bias in medicine has been predominantly revealed through procedural differences among ethnic groups, how patients of different ethnicities perceive their medical treatment, and structures that are barriers-to-entry for women and ethnic minorities. The current work revealed that the language found in everyday caregiver notes reflects disparities and indications of bias—new pathways that can complement other approaches to signal physicians who treat patients inequitably. Caregiver notes, based on their private nature, are akin to medical diaries for physicians as they attend to patients, logging the thoughts, feelings, and diagnoses of medical professionals. Caregivers have the herculean task of tending to those in need, though the current evidence suggests bias and language-based disparities are a part of this system.